Laparoscopic common bile duct exploration; a preferential pathway for elderly patients

Abstract

BackgroundLaparoscopic common bile duct exploration (LCBDE) has emerged as a recommended alternative to endoscopic retrograde cholangiopancreatography (ERCP) for the management of choledocholithiasis. However, its use in the elderly has been limited, and evidence of its safety and efficacy in these patients is yet to be established. This study describes our experience of LCBDE in elderly patients, analysing the safety and efficacy of this technique in comparison to younger patients.MethodsAll patients undergoing laparoscopic cholecystectomy (LC) with LCBDE for choledocholithiasis in our unit between January 2015 and January 2017 were included. Data pertaining to patient demographics, comorbidities, investigations, operative technique and outcomes were analysed. Patients were divided into 2 groups based on age (Group A:<65 years vs Group B: >/ = 65 years) for comparative analysis.Results124 patients (Group A: 65, Group B: 59) were included. Group B were more co-morbid and had a higher ASA grade than Group A. However, there was no significant difference between groups in rates of conversion to open or complications, including bile leak (3.1% vs 5.1%, p = 0.67), retained stone (4.6% vs 1.7%, p = 0.62), or complications according to Clavien-Dindo classification (p = 0.78). Re-intervention rates were also similar between groups (7.7% vs 3.4%, p = 0.44 and 3.1% vs 3.4%, p = 1.0 respectively), as was length of stay.ConclusionDespite higher frequency of comorbidities and ASA grade, LCBDE in elderly patients is safe and effective, and has similar outcomes to younger patients. Therefore elderly patients with choledocholithiasis should be offered LCBDE as an alternative to ERCP.

Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study

“…Several studies have reported the recurrence of CBDS after removal procedure and operations. Platt et al said the stone clearance rate was 96.7% in LCBDE, 90% in ERCP [14]. In a long-term follow-up study, Lee et al reported 5.9% of the recurrence rate of CBDS after LCBDE [15].…”

Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

“…With the development of endoscopic technique, ERCP is considered a preferred therapeutic method in management of CBD stones. However, it can be still challenging in some cases, such as high total hospital expenses and high risk of post-ERCP complications[21,22]. CP, one of the main modes to standardize treatment and care, is increasingly adopted by hospitals to strive to better outcomes and lower costs.…”

Preoperative Management of Obstructive Jaundice

“…Como conducta quirúrgica, para los 58 casos de coledocolitiasis; se realizó CPRE (colangioretrograda endoscópica) en 49 (84,48%) casos; y se terminó el tratamiento con una colecistectomía simple en 32 (55,17%) casos, colecistectomía más CIO (colangiografia intraoperatoria) en 9 (15,52%) casos y 1 (1,72%) caso requirió derivación biliodigestiva. Este manejo es diferente al manejo de otros centros, donde la coledocolitiasis diagnosticada preoperatoria o hallada en el intraoperatorio durante la colecistectomía, se resuelve en el mismo acto quirúrgico, con una exploración de la vía biliar por el conducto cístico o coledocotomía (31,31) . Existe varios estudios al respecto, sobre la ventaja o desventaja de la cirugía abierta o laparoscópica en comparación con la CPRE (1,(27)(28)(29)(30)32) .…”